What is CBT?
Cognitive Behavioral Therapy (CBT) is a structured goal-oriented treatment approach that can be shorter in length than other forms of psychotherapy. CBT is based on a combination of cognitive and behavioral theories about the mind, emotions and behavior. CBT is based on the concept that thoughts, feelings and actions are interconnected, and therefore making changes to even one of these leads to changes in the others. What we think affects how we feel and how we feel affects how we act and the choices we make. CBT operates under the notion that there are maladaptive thinking patterns involved in many of the things children and teens struggle with.
What does CBT treat?
CBT can be used to treat a variety of disorders and problems that kids face. This includes diagnoses such as separation anxiety, social anxiety, specific phobias, major depression, post-traumatic stress disorder as well as areas of struggle that may not reach the point of a diagnosis such as low self-esteem, chronic negativity, low grit or resilience, anger management difficulties and fear or worry. There are few things for which CBT cannot provide some benefit.
What is involved in CBT/What will my child learn?
Your child or teen will be learning new ways to REACT to tough situations! And each letter in the word REACT tells us something that will be worked on in CBT treatment: Rapport, Education, Affect awareness, Coping skills, Thought restructuring. Practice of all that is worked on in CBT and is critical to your child or teens success in treatment. This will be further discussed at the end of this blog. First, here is more information about the steps involved in CBT in the REACT acronym.
Rapport- It is essential for the therapist to build a good relationship and rapport with your child so that they will open up and be honest in therapy as well as be motivated to work hard. And CBT can be hard work! Expect the therapist to use toys, games, books, worksheets, or computer programs to make therapy fun for your child. They learn and grow best when they are having fun and comfortable. A portion of the session may be spent doing something your child or teen enjoys, and that is an important part of the process.
Education– CBT also begins with educating the child and family about the particular struggle bringing them to treatment and how their thoughts, feelings and/or actions are contributing to that struggle. Education is provided about the relationship between thoughts, feelings and behavior.
Affect Awareness/Feelings Identification and Regulation- In order to fully understand how thoughts, feelings and behaviors affect one another it is important for the child to have a grasp on a variety of emotions. The child or teen will develop or expand their feelings vocabulary and understanding of sensations that go with different emotions. Body cues are important signals to be aware of because they help us understand which emotions we are experiencing. Children and teens in CBT will become aware of when they have which emotions, what tends to trigger those emotions for them, and how to better regulate those emotions. Different tools help manage different feelings.
Coping Skills/Stress Management Strategies- Building a tool kit of coping skills is a core component of CBT. What ends up in your child or teen’s tool kit will depend both on what their particular struggle is as well as which coping skills “work” to provide relief for that particular individual. For example, progressive muscle relaxation (PMR) is a relaxation technique that helps many people with anxiety, but if PMR does not click with your anxious child there are many other relaxation techniques that can be taught. As a general rule, relaxation techniques are often taught for anxiety, calming strategies for anger, and techniques that increase enjoyment for depression. Whatever the presenting issue a tool kit of stress management techniques tailored to that issue and your child or teen will be developed.
Thought restructuring– Sometimes referred to as cognitive coping techniques, thought restructuring is a cornerstone skill of CBT. Children and teens first need to be able to differentiate their thoughts from their feelings/emotions. Not always as simple as it sounds in a world where we routinely use the word “feel” when we are actually talking about our thoughts (ex- “I feel like having pizza tonight” we are really thinking we want pizza, or “I feel like you’re mad at me” meaning I think you may be mad at me and I feel worried about it so I am bringing it up to you). The common thinking traps (sometimes referred to as cognitive distortions) the child or teen falls into are identified. Then work is done to help the child or teen learn to question whether those thoughts are accurate and/or helpful, and then to challenge, change or reframe unrealistic or unhelpful thinking with positive self-talk and more helpful thinking. Over time we are trying to change their default patterns to be less self-defeating and more resilient.
Who is involved in CBT?
Much of the work of CBT with a child or teen will be done one on one with the therapist. It is important for caregivers to be regularly involved as well to be able to support the child or teen in using the skills or strategies they are learning outside of session. It is common to get an update from a caregiver at the start of a session, and then to have the caregiver re-join again at the end for the child to either teach the caregiver what they have learned, or if culturally that is not comfortable, to be provided an update from the therapist.
How much therapy is needed?
CBT usually involves weekly therapy sessions that are 45-60 minutes in length. Sessions may be shorter for younger children or for children with limited attention spans, however at least 45 minutes is typical so that there is adequate time to update the caregiver about the session and what to work on at home or school. The more straightforward the issue, the shorter the course of treatment will be, and likewise more complex issues will likely require more sessions. CBT is generally thought of as a shorter-term therapy that a child will graduate from once attaining their treatment goals. It is not uncommon to return for shorter episodes of care in the future if there is a flare-up of the child’s struggles.
Why is my child getting homework for therapy?
Homework, or real-life practice, between sessions is an important part of CBT so that we are not just thinking and talking about these ideas, but instead are actively putting them into practice. If they are learning a new coping skill they need to practice it regularly to get comfortable enough doing it so that they can actually use it in the moment they are having a challenging thought or emotion. For anxiety the home practice is often referred to as “exposures” meaning we are exposing the child to the things that make them nervous or frightened through planned practice. For depression the practice may involve behavioral activation or positive event scheduling. Expect that your child or teen will have assignments of things to work on outside of therapy. Your support may be required for some of the practice, and other times there may be things for your child or teen to do on their own.
CBT helps give concrete strategies and education to lay the foundation for healthy thoughts, feelings and actions, and resilience in the face of life’s stressors.